Academy of Chiropractic’s Lawyers PI Program

Narratives 39

From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP

"Prognosis"























Reference:http://www.thefreedictionary.com/prognosis

prog·no·sis (prg-nss)

  1. a. A prediction of the probable course and outcome of a disease.
    b. The likelihood of recovery from a disease.
  2. 2. A forecast or prediction: a gloomy prognosis for economic recovery.

A prognosis is one of the big 3:

  1. Diagnosis
  2. Prognosis
  3. Treatment Plan

This is central to every healthcare profression in the world and simply says "can the patient be helped"? In our previous recommendations I have always held that in the conclusion you should (if clinically present) state that the patient's injuries are permanent, which is a prognosis. However in today's medical-legal environments, prognosis should be further clarified in the narrative.

There are 2 types of prognosis; static and stable.

Reference: http://www.thefreedictionary.com/static

Stat-ic

adjective

  1. a. Having no motion; being at rest; quiescent.

    b. Fixed; stationary.

A static diagnosis indicates that no further recovery is possible and the condition of the patient has stabilized. Permanent conditions fall under this category where MMI has been attained and no further care is necessary without the possibility of lifestyle or stress to cause the need for maintenance care. A lifetime of care can be required for static MMI, but the care will be nomore than palliative to allow the person to be pain free and maintain whatever function was regained. However no further improvement can be expected. 

According to James Mathis, former State Farm Supervisor and Allstate director, unless there is a static MMI assigned ot the pateint, the liklihood of having any great success in the medical-legal arena is small. 

Reference: http://www.thefreedictionary.com/stable

sta·ble
adj. sta·bler, sta·blest

  1. a. Resistant to change of position or condition; not easily moved or disturbed: a house built on stable ground; a stable platform.
    b. Not subject to sudden or extreme change or fluctuation: a stable economy; a stable currency. c. Maintaining equilibrium; self-restoring: a stable aircraft.

A stable prognosis indicates that although the patient has reached MMI, given stress, repetitive movements or simply time with unstable joints due to permanent connective tissue pathology as sequella from trauma, the patient will need periodic care to prevent further worsening and re-stabilize the joint. If you are considering more corrective care in your narrative, your patient's prognosis is "MMI Stable".

A damaged joint is no different than treating chronic high blood pressure or diabetes. The patient is stable, but will likely necessitate lifetime medication to manage the condition. A pathological joint, due to ligament failure as a sequella from trauma will unlikely be able to maintain normal joint function and require periodic stabilizing with furher correction possible.

When prognosing your patient, each injured body part should be considered individually. Should multiple body parts be injured, not all will necessarily respond the same and therefore it would be inaccurate to consider an overall prognosis static or stable if that is the case.

In addition, a final prognosis should be withheld until the last evaluation once MMI has been determined.

Sample Prognosis:

PROGNOSIS:
Mrs. Jones has attained maximum medial improvement (MMI) with the following clarification:
Static: No further recovery is expected and no further care should be needed
Stable: A state where little if any immediate change is expected and further periodic care will be required to re-stabilize the injured joint and prevent future worsening.
Cervical Spine: Static
Thoracic Spine: Static
Lumbar Spine: Static
Post Traumatic Headaches: Static
Knee Contusion: Stable

Click Here for an in-depth explanation, please read the article writtne by James Mathis and Mark Studin